Total hospital costs (THC) and length of stay (LOS) of endovascular coiling versus neurosurgical clipping for unruptured intracranial aneurysms: a systematic review and meta-analysis.

Total hospital costs (THC) and length of stay (LOS) of endovascular coiling versus neurosurgical clipping for unruptured intracranial aneurysms: a systematic review and meta-analysis.

World Neurosurg. 2018 Apr 12;:

Authors: Zhang X, Tang H, Huang Q, Hong B, Xu Y, Liu J

Abstract
OBJECTIVE: Comparison of feasibility and safety between endovascular coiling versus neurosurgical clipping for the management of unruptured intracranial aneurysms (UIA) has been incrementally reported. However, economic comparison has been rarely reported. This meta analysis aims at qualitatively and quantitatively analyzing the difference of hospital costs and length of stay between endovascular versus neurosurgical treatment in UIA.
METHODS: MEDLINE, the Cochrane database, EMBASE and Web of Science database were searched for cohort studies describing economic hospital cost or length of stay in patients with UIA. Two authors independently assessed study eligibility and rated quality using the Newcastle Ottawa Scale (NOS). Ravmen 5.2 was used to perform forest plot analysis.
RESULTS: A total of 9 studies were included describing 24,856 UIAs treated with neurosurgical clipping and 31,309 UIAs treated with endovascular coiling. Meta-analysis revealed that the total hospital costs (THC) were similar between coiling and clipping in UIA patients (SMD: -0.33, 95%CI: -0.68∼0.02, I2=99%, P=0.07). Subgroup analysis showed that THC of coiling was significantly lower than clipping in USA, however, opposite in South. Korea. 1-year medical costs of coiling were similar in both groups (SMD: -0.04, 95%CI: -0.08∼0.00, I2=0%, P=0.07). In addition, the length of stay of coiling were significantly shorter than that of clipping (SMD: 0.77, 95%: 0.75∼0.79, I2=95%, P<0.001).
CONCLUSION: Generally, no significant difference in total hospital costs and 1-year medical costs between coiling versus clipping in UIAs was observed. However, the length of stay of endovascular coiling was much shorter than neurosurgical clipping, and decreased over time.

PMID: 29656151 [PubMed - as supplied by publisher]

https://ift.tt/2qBnz5u